Optimizing treatment and analysis of prognostic factors for locally advanced nonsmall cell lung cancer in resource-limited population

Smoking tobacco, both cigarettes and beedis, is the principal risk factor for causation of lung cancer in Indian men; however, among Indian women, the association with smoking is not strong, suggesting that there could be other risk factors besides smoking. Despite numerous advances in recent years in terms of diagnostic methods, molecular changes, and therapeutic interventions, the outcomes of the lung cancer patients remain poor; hence, a better understanding of the risk factors may impact the preventive measures to be implemented at the community level. There is a lack of comprehensive data on lung cancer in India. In this review, we attempt to collate the available data on lung cancer from India.

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“…Nonsmoking status and the development of a CR to therapy significantly correlated with prolonged DFS and OS on multivariate analysis. [ 28 ]…”

Section: Therapy Of Lung Cancermentioning

confidence: 99%

Lung cancer in the Indian subcontinent

Noronha

Pinninti

Patil

et al. 2016

South Asian J Cancer

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“…2 Similar toxicity studies with CTRT have been reported by a tertiary care center in India. 15 In fact, in the Western literature, it is reported that the possibility of concurrent CTRT is only around 50%, and the remaining 50% have been excluded from such an approach owing to comorbidities or age-related poor tolerance. In this study, 15% of the patients had poor KPS, 30% were over 65 years of age, 20% had comorbidities, 84% were stage IIIB and above, 70% were smokers, and the median PTV was above 500 cc.…”

Section: Discussionmentioning

confidence: 99%

Consolidation Radiotherapy in M1a Non-small Cell Lung Cancer Yields Equivalent Outcomes as Locally Advanced Disease

Hashim,

Hegde,

Agrawal

et al. 2024

The Indian Journal of Chest Diseases and Allied Sciences

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Background:The role of locoregional radiotherapy (RT) in M1a [malignant pleural effusion (MPE)] non-small cell lung cancer (NSCLC) remains limited. Ninety percent of the patients who come to our clinic are at an advanced stage. The standard of care for advanced cases is chemotherapy. Chemotherapy may cause resolution of pleural fluid in some patients. Do patients with a good performance status benefit from radical radiation therapy? We present our RT experience in M1a NSCLC patients who responded to chemotherapy. Materials and methods: We studied patients with advanced NSCLC (locally advanced with/without pleural effusion) who received postchemotherapy radiation therapy between January 2005 and December 2019. These patients were given four cycles of cisplatin-pemetrexed/ gefitinib [epidermal growth factor receptor (EGFR)-positive] in adenocarcinoma and carboplatin-paclitaxel/cisplatin-etoposide in squamous cell carcinoma (SCC) followed by radical RT in three-dimensional (3D) [50-66 Gy conventional radiotherapy (CRT) technology]. Chemotherapy response, overall survival (OS), and factors affecting OS were evaluated by univariate and multivariate analysis. Results: A total of 36 of 154 patients had M1a disease. At a median follow-up of 14 months [interquartile range (IQR, 10-22 months)], the median OS was 14 months in the M1a subgroup vs 16 months in the non-M1a subgroup (p = 0.6). Median target volume was larger in M1a patients compared to M0 patients; 614 cc (IQR, 333-855 cc) and 564 cc (IQR, 391-763 cc). Factors affecting OS are gender (male vs female) (14 months vs 17 months in M0; 13 months vs 22 months in M1, p = 0.012), Karnofsky's performance is healthy (>70 vs <70) (14 months vs 11 months in M0; 18 months vs 13 months in M1, p = 0.04), diabetes (present vs not present) (12 months vs 14 months in M0; 10 months vs 16 months in M1, p = 0.03), chemical activity [biologically effective dose (BED) <72 vs >72)] (12 months vs 15 months in M0; 15 months vs 18 months in M1, p = 0.04), and radiation esophagitis (grade II vs grade I) (11 months vs 14 months in M0; 2 months vs 18 months in M0, p = 0.001). Conclusion: Primary RT is feasible and effective in chemotherapy-responsive NSCLC M1a patients; Despite a higher planned target volume (PTV) in M1a patients, it gives equivalent results compared to localized disease (M0). The potential of RT in this regard needs to be further validated.

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“…Half of the patients in the present study have PS of ECOG 1, also reported by previous published studies. [21][22][23] Single center studies reporting from the established tertiary cancer centers suggest adenocarcinoma being the most common NSCLC subtype. Krishnamurthy et al,24 in their retrospective analysis of data, extracted from a total of 25 consecutive hospital in patients with lung cancer at Adyar in Chennai between January 2003 and December 2007 reported that the most common histology was adenocarcinoma (42.6%), followed by squamous cell carcinoma (15.6%), large-cell carcinoma (2.3%), and others (7%).…”

Section: Discussionmentioning

confidence: 99%

Assessment of the clinicodemographic parameters and treatment outcomes of locally advanced and metastatic lung cancer cases – A retrospective study from northeast India

et al. 2023

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Background: There are many lacunae in our current understanding of the shifting epidemiological trends of lung cancer as well as lack of data among Northeast Indian patients. Aims and Objectives: This study tried to assess the clinicodemographic and treatment outcomes of advanced lung cancer cases. Materials and Methods: This was a retrospective hospital-based study. Patients with histopathologically confirmed locally advanced and metastatic lung cancer and were registered at Dr. Bhubaneswar Borooah Cancer Institute between January and December 2017 who were included in the study. A record was made of patient demographic-, clinical-, and treatment-related parameters. Kaplan–Meier survival curves were obtained. A two-tailed P<0.05 was considered statistically significant. Results: Majority of the patients were elderly males (median=60 years), with a history of smoking in three quarter of them. Non-small-cell lung carcinoma (94%) type was the most common histology. About 93% of patients presented with TNM stage IV disease. The most common palliative chemotherapy (CT) regimen used was taxanes and platinum doublet (n=24, 35%). With a median follow-up of 6 months (range 0–37), the median progression-free survival and overall survival were 8 months and 10 months, respectively. The median survival was significantly longer in patients younger than 60 years. (13 months; P=0.021) and in those with non-small-cell histology (10 months). Conclusion: In this audit of resource-limited population with advanced lung cancer, palliative CT remains the mainstay of treatment. There is a further need to improve the survival of these advanced cases in a cost-effective manner.

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Optimizing treatment and analysis of prognostic factors for locally advanced nonsmall cell lung cancer in resource-limited population

Cited by 8 publications

References 15 publications

Lung cancer in the Indian subcontinent

Lung cancer in the Indian subcontinent

Consolidation Radiotherapy in M1a Non-small Cell Lung Cancer Yields Equivalent Outcomes as Locally Advanced Disease

Assessment of the clinicodemographic parameters and treatment outcomes of locally advanced and metastatic lung cancer cases – A retrospective study from northeast India

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